One of the constraints in hospital waste management in Pakistan is ineffective legislation and the improper training about the collection, transportation and disposal of waste. In addition, unavailability of appropriate equipment for disposal (incinerators, autoclaves etc.) and insufficient budget to meet the expenses of waste management has led to many hospitals burning their waste in open environments. Lack of professional waste management teams, both at upper and lower levels, is another cause of hospital waste management failures in Pakistan. Unfortunately, scarce data is available on this issue therefore, this study has provided some of the baisc facts needed to improve hospital waste management.

Background

Open dumping of hospital waste is one of the biggest threats to the urban environments in Pakistan. Unprecedented risks are posed to public health when infectious hospital waste is openly burnt along with municipal waste. This has undermined the sustainability of breathing air quality in Rawalpindi city where population has been complaining about this issue but no proper action has been initiated to solve the problem.

Objectives

This study aimed to evaluate the waste generation, collection, segregation, transportations and disposal from major hospitals of Rawalpindi and its effect on the urban environment. An effort was made to document the effects of hospital waste burning on urban populations in order to find out the relation between ill-health effects faced by the people directly exposed to hospital waste burning.

Methodology

Primary data was collected through comprehensive surveys which included questionnaire form, personal observations, formal and informal meetings. Secondary data was collected from hospital records. Logistic Regression analysis was performed to evaluate the first hand response obtained during surveys and the presence/absence of any ill-health effect was analyzed in the context of exposure extent.

Results

The result indicated that approximately one sweeper is used for the cleaning of six beds and average daily waste generation rate was 1.55 kg day each bed, which contains 71% non-infectious and 14% infectious waste with 91% average bed occupancy rate. Three of the studied hospitals have separates waste bins for infectious and non-infectious waste collection. But unfortunately, the segregation of waste is only at the point of generation. Two of the studied hospital had wheel trolleys for waste collections while other used manpower for waste collection. Two of the studied hospitals had no proper place for the temporary storage of waste and none of the hospital had refrigerators/cooling room for the storage of pathological waste. Out of 254 responses collected during the questionnaire survey, 85% regarded themselves as directly exposed to waste burning fumes. Among ill-health effects attributed to hospital & municipal burning exposure includes in respiratory tract infections (Odds ratio = 3.18; 95% confidence interval 1.17 – 7.89) and eye irritations (Odds ratio = 2.66; 95% confidence interval 1.37 – 8.11).

Conclusion

Open burning of hospital and municipal waste must be immediately stopped as it appears to be an urban health issue. A well-managed waste administration team is required for all hospitals in Rawalpindi city to develop a multidirectional co-operation from all stakeholders, including federal and provincial governments, public, private hospitals and waste disposal staff.